BICA Registration Form

Please read notes for completing form here

BICA MEMBERSHIP APPLICATION Applicants must complete form electronically which expands as text is inserted. Membership details are recorded on a computer database accessible only to the BICA Executive & Accreditation Board. COMPLETE THIS FORM FULLY AS INDICATED, IF APPLYING FOR ACCREDITATION USE THE AMBICA OR SAMBICA FORM AS APPROPRIATE
Password must be at least 7 characters long.
  • Home
  • Work
  • Both
Please enter which address to use for correspondence
  • Telephone/Fax
  • Telephone
  • Email
  • Skype
  • Licensed Clinic - NHS
  • Private
  • Yes
  • No
  • Details
  • Yes
  • No
Do you wish to register for BICA Accreditation

I agree to abide by the following requirements:

  • Yes
  • No
  • Yes
  • No
To fulfil all BICA’s membership and accreditation requirements relevant to my membership category whilst a member
  • Yes
  • No
If a practising counsellor, to practise in accordance with ‘BICA Guidelines for Good Practice in Infertility Counselling’
  • Yes
  • No
*Are you currently the subject of a formal complaint to BICA or any other relevant professional body?
  • Yes
  • No
*Have you been the subject of a formal complaint to BICA or any other relevant professional body where the complaint was upheld against you?
  • Yes
  • No
*Have you been refused recognition, certification or accreditation by BICA or any other relevant professional body?
  • Yes
  • No
*Have you ever been convicted of a criminal offence of violence, dishonesty or exploitation?

If any of the above * apply you should provide confidential details on a separate sheet.

I declare that my application is accurate, complete and honest to the best of my knowledge. I understand that any misleading or inaccurate information given or anything relevant omitted, may, when discovered, invalidate my application and/or cause my membership and/or accreditation to be withdrawn and my membership terminated. I accept and fulfil all requirements relevant to Membership of BICA and accept that membership alone does not of itself imply recognition of competence by BICA without accreditation. Any material which might be regarded as confidential has been appropriately protected by the applicant or permission gained for its usage.

  • Yes
  • No
Do you require Gift Aid?
  • Yes
  • No
Would you like to opt in for subscription to our newsletter, updates and relevant information?

Please send your fee of £60 for membership, [plus £25 if registering for accreditation 3] £60 overseas membership  £140 corporate Membership

Payment can be made by:

PayPal using the links below

Or paid by bank transfer to Co-operative Bank ‘BICA’ a/c 65000812, Sort Code 08.90.82


Bica Fees



Download Gift Aid application